NPIMap

Organization Active NPI

Experience Momentum, Inc - Mill Creek

  • Physical Therapist
  • Mill Creek, WA
National Provider Identifier
1609577188
Registry record updated Mar 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
EXPERIENCE MOMENTUM, INC - MILL CREEK
Practice address
16709 9TH Ave SE
Ste E
Mill Creek, WA 98012
Phone
(425) 967-5605
Fax
(425) 776-0803
NPI assigned
Mar 13, 2023
Organization subpart
Yes
Parent organization
EXPERIENCE MOMENTUMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rhoda Chavez-Nowlan
Title
Billing Manager, Finance
Phone
(425) 776-0803

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 133V00000X
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X Primary
Massage TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225700000X
Physical Therapy Clinic/Center 261QP2000X

Addresses

Primary practice location

16709 9TH Ave SE
Ste E
Mill Creek, WA 98012

Mailing address

4030 Alderwood Mall Blvd
Lynnwood, WA 98036-6763
Phone (425) 776-0803

National Provider Directory

National Provider Directory
Tax ID family
Experience Momentum Inc - Mill Creek3 organizations share this tax ID, including this one
Part of
Experience Momentum Inc - Mill Creek

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678665600000",
    "number": "1609577188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4030 ALDERWOOD MALL BLVD",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980366763",
            "telephone_number": "425-776-0803",
            "fax_number": "425-776-0813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16709 9TH AVE SE",
            "address_2": "STE E",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "98012",
            "telephone_number": "425-967-5605",
            "fax_number": "425-776-0803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXPERIENCE MOMENTUM, INC - MILL CREEK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EXPERIENCE MOMENTUM",
        "enumeration_date": "2023-03-13",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-13",
        "status": "A",
        "authorized_official_last_name": "CHAVEZ-NOWLAN",
        "authorized_official_first_name": "RHODA",
        "authorized_official_title_or_position": "BILLING MANAGER, FINANCE",
        "authorized_official_telephone_number": "425-776-0803"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mill Creek, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.